What methods are available to test for HPV infection?

  HPV is not yet available for in vitro viral culture, and the sensitivity of staining microscopy methods after tissue sectioning or cell smear is relatively low, while serological methods commonly used clinically for the detection of other pathogens are not reliable for the diagnosis of HPV infection in terms of results. Current clinical means of direct or indirect detection of HPV include the following: First, tissue biopsy, which is determined by morphological changes in cells. Typical alterations are epidermal cells with perinuclear vacuoles, etc. Further immunohistochemical testing can also be performed with high accuracy, but the practical application is relatively modest because it is an invasive operation and troublesome to obtain material. The second is liquid-based cytological testing (TCT), TCT can also detect the presence of HPV infection to some extent, although the sensitivity is poor compared with the methods of molecular biology detection. Third, it relies on molecular biology technical means for HPV DNA detection, including nucleic acid hybridization and PCR methods, etc. Depending on the specific method, HPV can be detected quantitatively and typed. These methods include traditional hybridization methods, hybridization capture methods, PCR methods, etc. The following is a brief description of the molecular biology methods.  I. Traditional hybridization method High specificity, intuitive and other advantages, but complex operation, lower sensitivity than PCR method, and the need for fresh tissue samples, not convenient for clinical promotion.  Second, hybridization capture method The second-generation hybridization capture method HybridCaptureSystems (HC2) produced by Digene is a liquid-phase hybridization method, which is the only HPV DNA detection technology approved by the U.S. Food and Drug Administration, and it can simultaneously detect 13 high-risk types of viruses (HPVl6, 18, 31, 33, 35 39, 45, 51, 52, 56, 58, 59, 68) and 5 low-risk types of viruses (6, 11, 42, 43, 44). Although the U.S. CDC approved the HC2 test for low-risk types, the current domestic reagents can only detect high-risk types. HC2 high-risk type detection is more sensitive and reproducible, but its disadvantage is that it cannot identify specific HPV subtypes and the test is expensive, which makes it difficult to promote in less economically developed areas. In addition, HC2 has certain problems of cross-hybridization, which can sometimes cause false-positive results.  HC2 testing is currently an important and commonly used method in the field of clinical high-risk HPV testing and is the preferred method for cervical cancer screening. the unified clinical determination criteria for HC2 is ≥1.0 pg/ml (equivalent to 5000 viral copies/time). It should be specifically noted that a negative HC2 HPVDNA test result does not mean complete absence of HPV infection, it just means that the HPV level in their body is lower than 5000 copies per test. With viral levels below this level, the likelihood of developing cervical epithelial neoplasia CIN grade 2/3 lesions within at least 3-5 years is very low. In other words, the risk of developing cervical cancer is very low. If the test result is positive, HC2 HPV DNA ≥ 1.0pg/ml (5000copies/ml), then regular HC2 review should be performed annually. If the test result is positive for two consecutive years, the doctor should be consulted for the next step of examination or treatment, and women older than 30 years of age should be monitored more closely. Monitoring HC2 in patients after cervical cancer surgery can predict the risk of lesion deterioration or recurrence after surgery.  III. PCR method The PCR-based test is currently considered a better method for HPV DNA detection and typing, and is mainly divided into two parts: gene amplification and product analysis. It can be used for HPV qualitative and semi-quantitative testing, DNA sequencing and mutation analysis.  1, PCR gene amplification including general primer PCR (GP-PCR), type-specific PCR (TS-PCR) and real-time fluorescence quantitative PCR (RQ-PCR) and other methods.  2, PCR product analysis including gene chip (also known as DNA chip) method, restriction fragment length polymorphism analysis (RFLP), sequencing method and hybridization analysis method. The gene microarray method can be used for HPV typing and diagnosis of mixed infections, and has the characteristics of high throughput, high sensitivity and specificity, which can be used for large-scale screening and is more suitable for epidemiological investigation and research on vaccines.  HPV testing in men is also important, as studies have shown that men with multiple sexual partners are “carriers” of both high- and low-risk HPV. Men with high-risk HPV infection are primarily subclinically infected. In the past, HPV infection in men was detected by penile lavage or semen testing for HPV DNA, but there were disadvantages such as difficulties in obtaining material, low sensitivity of the test, complicated experimental procedures, and lack of normal controls.  At present, there is no clinical method for HPV detection that is both typing and quantitative, very accurate and inexpensive. To solve this problem, one is to perform different tests according to different purposes, and one tends to combine applications, for example, liquid-based cytology testing (TCT) combined with cellular HC2 testing, or gene chip for screening followed by semi-quantitative HC2 testing. In addition, simultaneous testing of sexual partners is important both for acromegaly caused by HPV low-risk types and for diseases such as cervical cancer caused by HPV high-risk types.